ICU and Forensics

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ICU and Forensics
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OBJECTIVES

• Describe information which should be consistently
  communicated by healthcare providers for those
  patients thought to be injured due to a violent
  crime.
• List items which the healthcare provider may see
  that could be considered evidence.
• Review the steps in preserving evidence with the
  chain of custody.
• Discuss HIPAA, Protected Health Information
  (PHI) and how these impact information relayed to
  detectives or investigators

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Nurse to Nurse Report

• Report from unit to unit and shift to shift
• should include information related to
• patient status
• any ongoing evidence collection
• pertinent information related to an ongoing
  criminal investigation

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Care of the patient/care of the evidence

• Gone are the days when the healthcare clinician
  could opt out of addressing forensic issues with
  patients by claiming their need to save a life or
  to focus soley on physical care needs at the cost
  of preserving evidence and all that is entailed
  with forensic considerations (Sekula, 2005)
• 
  

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PATIENT CARE

• Maintain airway
• Maintain hemodynamic stability
• Replace volume
• Watch for signs and symptoms
• of complications.

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EVIDENCE CARE

• Holistic nursing includes
• Evidence collection
• Preservation of evidence
• Maintaining chain of custody of evidence

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What items can be considered evidence?

• Patient clothing
• Debris from patient hair or
• body
• The description of the wound

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• Maintaining the chain of custody for evidence
  includes documentation of its possession from the
  time the item(s) are removed from the patient
  until shown in court.

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Patients who are victims of violent crimes

• Should be listed in the hospital directory as a
  No Information
• Protecting healthcare providers, other patients
  and the victim are a priority
• Watch for visitors who exhibit suspicious or
  negative behaviors

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• FAMILY
• Immediate family may visit
• if approved by security
• Medical information should
• only be given as approved by
• patient.
• If patient is unable to respond
• give information as designated by law.

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WHAT CAN BE TOLD TO DETECTIVES/INVESTIGATORS

• Verbal comments made by family or patients that
  may be pertinent to the investigation
• Dont forget to document this information in
  quotes in the nursing record

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Detectives/Investigators

• Per the Department of Health and Human Services
  PHI may be shared with law officials for
  enforcement purposes in 6 defined scenarios and
  specific conditions

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• As required by law such as a court order, court
  ordered warrant, subpoenas and administrative
  requests
• To identify or locate a suspect,
• fugitive, material witness or missing person
• In response to a law enforcement request for
  information about a victim or suspected victim of
  a crime

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• To alert law enforcement of a persons death if
  the healthcare entity believes that criminal
  activity caused the death
• If the protected health information is evidence
  of a crime that occurred
• on the entity property
• By a covered health care provider
• in a medical emergency not occurring on the
  premises and the information is needed to
  describe the crime, the victims and the
  perpetrator.

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• If none of these criteria are met than the
• patient must consent to the release of PHI

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What if the patient is incapacitated and unable
to consent?
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PHI may be released if

• The information is needed to determine if a law
  was violated and the PHI will not be used against
  the patient (victim)
• The investigation would be negatively impacted by
  a delay in getting this information.
• The entity believes the release of the
  information is in the best interest of the
  patient.

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• For further information related to the release of
  PHI for law enforcement purposes visit the
  Department of Health and Human Services website.
• http//www.hhs.gov/ocr/privacysummary.pdf
• Additionally check with your entities specific
• guidelines related to PHI.

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Written documentation

• Should include
• Statements made by the patient, visitors or
  family that the in the healthcare providers
  professional judgment could be important to the
  investigation. Use quotation marks in your
  documentation.
• Types and locations
• of the wounds
• If evidence was collected
• how, where, what and who

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Medical Examiner

• This patient developed ARDS, renal failure and
  continued to decline. After 3 days the patient
  expired.
• Medical Examiners office notified of his death
  and an autopsy was ordered.

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REFERENCE

• Department of Health and Human Services.
  (2002). Standards for
• privacy of individually identifiable health
  information final rule. (45 CFR
• Parts 160 and 164) On-line. Available
• http//www.hhs.gov/ocr/hipaa/privrulepd.pdf
• Department of Health and Human Services.
  (2003). OCR Privacy
• Brief. On-line. Available http//www.hhs.gov/o
  cr/privacysummary.pdf
• Evans, M.M., Stagner, P.A. (2003).
  Maintaining the chain of
• custody, evidence handling in forensic cases.
  AORN Journal 78 (4),
• 563-567.
• Sekula, K.L. (2005). The Advance Practice
  Forensic Nurse in the
• Emergency Department. Topics in Emergency
  Medicine 27 (1), 5-14.